title: Mastery learning for health professionals using technology-enhanced simulation: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Competency-based education requires individualization of instruction. Mastery learning, an instructional approach requiring learners to achieve a defined proficiency before proceeding to the next instructional objective, offers one approach to individualization. The authors sought to summarize the quantitative outcomes of mastery learning simulation-based medical education (SBME) in comparison with no intervention and nonmastery instruction, and to determine what features of mastery SBME make it effective.
  
  
  METHODS
  The authors searched MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, Scopus, key journals, and previous review bibliographies through May 2011. They included original research in any language evaluating mastery SBME, in comparison with any intervention or no intervention, for practicing and student physicians, nurses, and other health professionals. Working in duplicate, they abstracted information on trainees, instructional design (interactivity, feedback, repetitions, and learning time), study design, and outcomes.
  
  
  RESULTS
  They identified 82 studies evaluating mastery SBME. In comparison with no intervention, mastery SBME was associated with large effects on skills (41 studies; effect size [ES] 1.29 [95% confidence interval, 1.08-1.50]) and moderate effects on patient outcomes (11 studies; ES 0.73 [95% CI, 0.36-1.10]). In comparison with nonmastery SBME instruction, mastery learning was associated with large benefit in skills (3 studies; effect size 1.17 [95% CI, 0.29-2.05]) but required more time. Pretraining and additional practice improved outcomes but, again, took longer. Studies exploring enhanced feedback and self-regulated learning in the mastery model showed mixed results.
  
  
  CONCLUSIONS
  Limited evidence suggests that mastery learning SBME is superior to nonmastery instruction but takes more time.
authors.affiliation: Office of Education Research, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. david33@mayo.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Cook
authors.forename: Ryan
authors.initials: R
authors.lastname: Brydges
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zendejas
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Hamstra
authors.forename: Rose
authors.initials: R
authors.lastname: Hatala
mesh_terms: D003162:Competency-Based Education / Q000379:methods*; D003198:Computer Simulation; D004501:Education, Medical / Q000379:methods; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007858:Learning; D012106:Research / Q000193:education*; D012107:Research Design